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Diagnostic accuracy of anti-MCV and anti-CCP antibodies in rheumatoid arthritis

A meta-analysis

Diagnostische Genauigkeit von Anti-MCV- und Anti-CCP-Antikörpern bei rheumatoider Arthritis

Eine Metaanalyse

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Abstract

Objective

The purpose of this study was to compare the diagnostic performance of anti-mutated citrullinated vimentin (anti-MCV) and anti-cyclic citrullinated peptide (anti-CCP) antibodies in rheumatoid arthritis (RA).

Methods

We searched the Medline, Embase, and Cochrane library databases and performed two meta-analyses on the diagnostic accuracy of anti-MCV and anti-CCP in patients with RA compared to healthy controls.

Results

We identified 12 studies that included a total of 2003 RA patients and 831 healthy controls for the meta-analysis. The pooled sensitivity and specificity of anti-MCV were 68.6 % [95 % confidence interval (CI) 66.6–79.7] and 94.2 % (95 % CI 92.4–96.7) and those of anti-CCP were 61.7 % (95 % CI 59.5–63.8) and 97.1 % (95 % CI 96.7–98.1), respectively. Anti-MCV PLR, NLR, and DOR were 12.99 (95 % CI 8.013–21.27), 0.297 (95 % CI 0.238–0.369), and 47.78 (95 % CI 28.59–79.84), and those for anti-CCP were 16.71 (95 % CI 11.42–24.47), 0.378 (95 % CI 0.325–0.439), and 54.20 (95 % CI 31.65–92.82), respectively. The AUC of anti-MCV was 0.886, and its Q* index was 0.817, indicating modest accuracy, while the AUC of anti-CCP was 0.946, and its Q* index was 0.885. The sensitivity of anti-MCV was significantly higher than that of anti-CCP in the diagnosis of RA (difference 0.069, 95 % CI 0.039–0.098, p < 0.0001), but the specificity of anti-MCV was lower than that of anti-CCP (difference − 0.029, 95 % CI − 0.051 to − 0.006, p = 0.012). The Q* index of anti-MCV was significantly lower than that of anti-CCP (difference − 0.068, 95 % CI − 0.070 to − 0.065, p < 0.0001).

Conclusion

Our meta-analysis demonstrates that anti-MCV is more sensitive but less specific, and has lower diagnostic accuracy than anti-CCP in RA, although anti-MCV and anti-CCP showed comparable high PLRs.

Zusammenfassung

Zielsetzung

Ziel dieser Studie war es, die diagnostische Leistung von Antikörpern gegen mutiertes citrulliniertes Vimentin (Anti-MCV) und zyklisches citrulliniertes Peptid (Anti-CCP) bei rheumatoider Arthritis (RA) zu vergleichen.

Methoden

Wir durchsuchten die Medline-, Embase- und Cochrane-Datenbanken und führten zwei Metaanalysen bezüglich der diagnostischen Genauigkeit von Anti-MCV- und Anti-CCP-Antikörpern bei Patienten mit RA im Vergleich mit einer gesunden Kontrollgruppe durch.

Ergebnisse

Für die Metaanalyse identifizierten wir 12 Studien, die insgesamt 2003 RA-Patienten sowie 831 Personen in den Kontrollgruppen einschlossen. Die gepoolte Sensitivität und Spezifität von Anti-MCV lag bei 68,6 % [95 % Konfidenzintervall (CI) 66,6–79,7] und 94,2 % (95 % CI 92,4–96,7), die von Anti-CCP bei 61,7 % (95 % CI 59,5–63,8) und 97,1 % (95 % CI 96,7–98,1). PLR-, NLR- und DOR-Werte betrugen für Anti-MCV 12,99 % (95 % CI 8,013–21,27), 0,297 (95 % CI 0,238–0,369) sowie 47,78 (95 % CI 28,59–79,84) und für Anti-CCP 16,71 (95 % CI 11,42–24,47), 0,378 (95 % CI 0,325–0,439) sowie 54,20 (95 % CI 31,65–92,82). Die AUC von Anti-MCV lag bei 0,886 mit einem Q-Index von 0,817, was eine moderate Genauigkeit zeigt, während die AUC von Anti-CCP 0,946 betrug mit einem Q-Index von 0,885. Für die Diagnose von RA war die Sensitivität von Anti-MCV signifikant höher als die von Anti-CCP (Differenz: 0,069, 95 % CI 0,039–0,098; p < 0.0001), die Spezifität von Anti-MCV war jedoch geringer als die von Anti-CCP (Differenz: − 0,029, 95 % CI − 0,051 bis − 0,006; p = 0,012). Der Q-Index von Anti-MCV war signifikant geringer als der von Anti-CCP (Differenz: − 0,068, 95 % CI − 0,070 bis − 0,065, p < 0,0001).

Schlussfolgerung

Unsere Metaanalyse zeigt, dass Anti-MCV eine höhere Sensitivität, aber eine geringere Spezifität als Anti-CCP besitzen und bei der Diagnose von RA eine geringere Genauigkeit aufweisen, obwohl Anti-MCV und Anti-CCP vergleichbar hohe PLR-Werte zeigten.

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Acknowledgments

This study was supported in part by a grant of the Korea Healthcare technology R&D Project, Ministry for Health and Welfare, Republic of Korea (HI13C2124).

Compliance with ethical guidelines

Conflict of interest. Y.H. Lee, S.-C. Bae, and G.G. Song state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, 136–705, Seoul, Korea

    Y.H. Lee MD, PhD & G.G. Song

  2. Division of Rheumatology, Department of Internal Medicine, The Hospital for Rheumatic Diseases, Hanyang University Medical Center, Seoul, Korea

    S.-C. Bae

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  1. Y.H. Lee MD, PhD
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  3. G.G. Song
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Correspondence to Y.H. Lee MD, PhD.

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Lee, ., Bae, SC. & Song, G. Diagnostic accuracy of anti-MCV and anti-CCP antibodies in rheumatoid arthritis. Z Rheumatol 74, 911–918 (2015). https://doi.org/10.1007/s00393-015-1598-x

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